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Organization

EYES ON MAIN INCORPORATED

Active
Other names
EYES ON MAiN
Organization subpart
No

Provider details

NPI number
Authorized official
JEFFREY C SQUIRE OD (PRESIDENT)
(406) 586-2173
Entity
Organization

Contact information

Practice address
1425 W MAIN ST, UNIT B, BOZEMAN, MT 59715-3283
(406) 586-2173
Mailing address
1425 W MAIN ST, UNIT B, BOZEMAN, MT 59715-3283
(406) 586-2173

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
657
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000028361
BCBS OF MONTANA
MT
01
000085167
MEDICARE GROUP PIN
MT
05
0483752
MT
01
1982766747
INDIVIDUAL NPI NUMBER
Enumeration date
12/21/2007
Last updated
03/07/2023
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